There is a chronic inflammation to the mucosal and sub mucosal layers of the colon in ulcerative colitis. Studies have shown that this condition is common in young and middle-aged adults. However, it could also occur at any age. Patients who suffer from ulcerative colitis may experience prolonged remission and others may have mild or severe symptoms (Timby and Smith 650). Signs and Symptoms of Ulcerative Colitis The symptoms may vary according to its location. Medical doctors categorize ulcerative colitis in relation to its site.
The following are the signs and symptoms of ulcerative colitis: Ulcerative proctitis- the inflammation is restricted to the rectum. Some patients may have rectal bleeding. Other patients may experience rectal pain, “a feeling of urgency or an inability to move the bowels” (Ulcerative Colitis, 2007, www. mayoclinic. com) Left-sided colitis- the inflammation expands from the rectum and to the left side and to the sigmoid and descending colon. Signs and symptoms include bloody stool diarrhea, abdominal pain and weight loss (Ulcerative Colitis, 2007, www.
mayoclinic. com). Pancolitis- there is complete inflammation of the colon. Signs and symptoms of this condition includes” bloody diarrhea, abdominal cramps and pain, night sweats and weight loss” (Ulcerative Colitis, 2007, www. mayoclinic. com). Fulminant colitis- is a life-threatening type of colitis that “affects the entire colon” (Ulcerative Colitis, 2007, www. mayoclinic. com). Signs and symptoms include abdominal cramping, severe diarrhea, “dehydration and shock” (Ulcerative Colitis, 2007, www. mayoclinic. com).
Patients who suffer from fulminant colitis may have severe complications such as a ruptured colon and toxic megacolon (Ulcerative Colitis, 2007, www. mayoclinic. com). The case of ulcerative colitis changes with episodes of acute illness and remission. Over a period of time, the severity of the disease is unchanged. Patients who suffer from ulcerative proctitis may experience severe signs and symptoms (Ulcerative Colitis, 2007, www. mayoclinic. com). Diagnosis There are a series of tests in diagnosing ulcerative colitis. A medical history is taken followed by a physical exam.
Blood tests are done to check if the patient has anemia that would show bleeding in the colon or rectum. If tests reveal that there is an increased of white blood cell, this would indicate that there is an inflammation in the body (Ulcerative Colitis, 2006, Medline Plus, www. digestive. niddk. nih. gov). A stool sample may be taken during this period. The presence of white blood cells shows that there is inflammatory disease. This test also uncovers bleeding or infection in the colon or rectum that is brought about by bacteria, virus or parasites (Ulcerative Colitis, 2006, Medline Plus, www.
niddk. nih. gov). Colonoscopy and sigmoidoscopy are used in diagnosing ulcerative colitis. These procedures also “rules out Crohn’s disease, diverticular disease and cancer. In both tests, the doctor will use an endoscope which is a long, flexible, lighted tube connected to a computer and TV monitor-that goes through the anus to visualize the colon and the rectum” (Ulcerative Colitis, 2006, Medline Plus, www. digestive. niddk.. nih. gov). This would allow the doctor to visualize inflammation, bleeding and ulcers on the wall of the colon.
The doctor may also perform a biopsy in which tissue samples may be taken from the lining of the colon wall and it would be observed under a microscope (Ulcerative Colitis, 2006, Medline Plus, www. digestive. niddk. nih. gov). “X-rays, barium enema and CT scans may also be used as a tool for diagnosing ulcerative colitis and its complications” (Ulcerative Colitis, 2006, Medline Plus, www. digestive . niddk. nih. gov). Medical and Surgical Treatment Medical treatment is used toward attaining and sustaining remission. The diet is modified to increase caloric and nutritional content.
The client is advised to stop eating foods that leads to pain and discomfort. If all food that were ingested causes discomfort, the symptoms reveal that these were the result of the disease process and not the food that was taken in. The patient may be given Total Parenteral Nutrition (TPN) and lipid infusions to rest the bowel. The use of elemental diet as described for Crohn’s disease is not yet proven effective in the case of ulcerative colitis (Timby and Smith 650). Blood transfusions and iron are given to treat anemia. The patient may also be given “parenteral fluids and electrolytes.
Supplementary vitamins are prescribed, with frequent bowel movements, which interfere with the absorption of the nutrients” (650). Medications prescribed for Crohn’s disease may also be given for patients suffering from ulcerative colitis. “The 5-ASA medications include sulfasalazine (Azulfidine), olsalazine (Dipentum), and mesalamine (Asacol, Pentasa). Mesalamine is available in enema or suppository form (Rowasa) that is used to treat distal disease” (647). Patients who are afflicted by ulcerative colitis are given corticosteroids such as prednisone, prednilosone and cortisone if they fail to respond to the 5-ASA medications.
It should be noted that systemic corticosteroids are not often effective in keeping remission for patients with ulcerative colitis. They may suffer from adverse effects of using corticosteroids. The use of corticosteroids is gradually tapered to reduce untoward side effects. Clients who are “dependent and unresponsive to corticosteroids are treated with surgery and immunomodulator treatments. ” (Ulcerative Colitis, 2007, www. medicinenet. com). Azathrioprine/6-MP, methotrexate, and cyclosporine are immunomodulator prescribed in treating severe ulcerative colitis (Ulcerative Colitis, 2007, www.
medicinenet. com). An ulcerative drug called “Infliximab (Remicade) may be prescribed in controlling moderate to severe ulcerative colitis” (Ulcerative Colitis, 2007, www. medicinenet. com). The patient may undergo surgical treatment when the disease does not respond to medical treatment or if the disease is accompanied by “dysplastic tissue (a precancerous condition), ruptured colon, or hemorrhage” (Timby and Smith 651). Surgery will involve “protocolectomy which is the removal of the entire colon and rectum. In the past, an ileostomy bag is placed under an opening on the abdomen to collect fecal matter.
Nowadays, a procedure known as ileoanal anastomosis can be done and this reduces the use of ileostomy bag. In this procedure, the surgeon creates a pouch from the end of the small intestine and it is attached directly to the anus” (Ulcerative Colitis, 2007, www. mayoclinic. com). This procedure permits the patient to eliminate waste materials normally. However, five to seven soft or watery stools are expected as a result of this procedure because the water can no longer be absorbed since the colon has been removed. The surgical procedure will be explained by the surgeon to the client.
The use of ileostomy bag or ileostomy pouch will be discussed with the patient. Studies show that 25 to 40 percent of patients suffering from ulcerative colitis may require surgical treatment (Ulcerative Colitis, 2007, www. mayoclinic. com). Self -Care Patients that are suffering from ulcerative colitis may require a change in diet. This includes eating less dairy products because this would help prevent diarrhea, abdominal pain and gas. A diet that is low in lactose may be discussed with a dietitian (Ulcerative Colitis, 2007, www. mayoclinic.
com). Patients with ulcerative colitis are also advised to eat foods that are high in fiber. This includes eating fruits and vegetables and whole grains (Ulcerative Colitis, 2007, www. mayoclinic. com). Gas forming foods should also be avoided such as beans, cabbage, spicy food, alcohol, caffeine, soda and chocolate (Ulcerative Colitis, 2007, www. mayoclinic. com) The patient is also advised to eat small meals a day rather than eating three large meals. Drinking plenty of water assists in good bowel movements (Ulcerative Colitis, 2007, www.
mayoclinic. com). The doctor may advise the patient to take supplementary vitamins in providing lost nutrients (Ulcerative Colitis, 2007, www. mayoclinic. com). It is important to see a registered dietitian in planning a patient’s diet especially at the onset of weight loss (Ulcerative Colitis, 2007, www. mayoclinic. com). The patient should also avoid stress and learn to manage it through exercise, biofeedback, relaxation and breathing exercises (Ulcerative Colitis, 2007, www. mayoclinic. com).
Works Cited
“Ulcerative Colitis”. 17 August 2007.http://www. mayoclinic. com/health/ ulcerative-colitis. htm. Retrieved on 12 January 2007. “Ulcerative Colitis”. 10 January 2008. Medline Plus. http://www. digestive. niddk. nih. gov. /ddiseases/pubs/colitis/#diagnose. Retrieved on 12 January 2008. “Ulcerative Colitis”. 27 August 2007. http://www. medicinenet. com/ulcerative_colitis. htm. Retrieved on 12 January 2007. Timby, Barbara K. and Nancy E. Smith. “Ulcerative Colitis”. Essentials of Nursing: Care of Adults and Children. Philadelphia: Lippincott Williams and Wilkins, 2005.